两种胰肠吻合术式与胰瘘关系探讨

Investigation of pancreatic fistula occurrence for two types of pancreaticojejunostomy

目的分析比较粘合式胰肠吻合方式与双层套入式吻合方式发生胰瘘并发症的差异。方法对1999年1月至2006年1月期间57例胰十二指肠切除术病例资料进行回顾性分析研究,依据术中胰肠吻合方式的不同,分为粘合式胰肠吻合组和双层套入式吻合组,比较两组间手术时间、出血量、平均住院时间和胰瘘发生率的差异。结果无手术死亡。两组手术时间、出血量和平均住院时间无统计学差异。套入式吻合组发生胰肠吻合口瘘1例(2.9%)、单纯性胰瘘6例(17.6%),粘合式吻合组无胰瘘发生。两组胰肠吻合口瘘差异无统计学意义(P>0.05),套入式吻合组单纯性胰瘘显著高于粘合式吻合组(P<0.05)。胰瘘经保守治疗均治愈。结论胰肠吻合术式对胰瘘发生率有一定的影响,粘合式胰肠吻合术式可以有效地降低胰瘘发生率。

Objective To analyze and compare the difference of two types of pancreatic fistula occurred in pancreatoduodenectomy patients following two types of pancreaticojejunostomy. Methods From January 1999 to January 2006, 57 cases operated with pancreatoduodenectomy were analyzed retrospectively. They were classified conglutinated pancreaticojejunostomy with adhesion of fibrin glue group and end-to-end two-layer invaginated pancreatieojejunostomy group according to difference of anastomotic mode, in which we compared the average operation duration, volume of blood loss, hospitalization time and pancreatic fistula rate. Results No death happened. There in no statistical defference in the average operation duration, volume of blood loss and hospitalization time. One ease of anastomotic pancreatic fistula and 6 cases of simple pancreatic fistula happened in end-to-end two-layer invaginated pancreaticojejunostomy group, while none pancreatic fistula was found in conglutinated pancreaticojejunostomy with adhesion of fibrin glue group. Them was no statistical significanoe in anastomotic pancreatic fistula between the two groups, but the defference of simple pancreatic fistula showed statistical significance. These pancreatic fistulae were all cured by conservative therapy. Conclusion The type of pancreaticojejunostomy has a certain extent influence on the pancreatic fistula rate, which can effectively reduce by adopting eonglutinated pancreaticojejunostomy with adhesion of fibrin glue.